L.A. Care Has You Covered
L.A. Care Health Plan is proud to participate in Covered California™ to offer health insurance to Los Angeles County residents. The 2018 Open Enrollment period for Covered California is now closed and will reopen in the fall of this year. But certain life events still make you eligible to apply for health coverage through Special Enrollment, such as marriage or losing a job. Please take a look at L.A. Care's Enrollment Periods to learn more about Special Enrollment.
Your health and that of your loved ones is our primary mission. Just as it has been for the past 20 years. We are here to answer your questions and to help you find the best health coverage for your needs and the needs of your family. You can still call our Enrollment Support Services Team at 1-855-222-4239 (TTY 711).
Shop with confidence knowing that you can get affordable health coverage through L.A. Care. Even though President Trump ended subsidies to health insurers, a consumer subsidy was not affected and is still available under the Affordable Care Act (ACA). Most residents like you are still eligible for a consumer subsidy, and this is what is keeping your 2018 premium costs affordable.
L.A. Care has the most affordable premiums in Los Angeles County for the Silver, Gold and Platinum metal levels. Take a look at our plan options and see the many ways that L.A. Care Covered™ makes getting care as easy as possible for our members.
- Our plans offer preventive care at no additional cost. This means that you may have no co-pays or co-insurance, and you do not have to meet your deductible (if there is one for your plan), before full coverage for preventive care services begin.
- Members have access to an extensive network of doctors, specialists, hospitals, pharmacies and preventive care services- close to where they live, work and play.
- A free Nurse Advice Line is available to all members, 24 hours a day, 7 days a week.
- Health education and exercise classes and disease management programs are available at no cost through our Family Resource Centers.
L.A. Care Covered™
L.A. Care Covered™ plans offer the same essential health benefits across all metal levels (Platinum, Gold, Silver and Bronze). The amount of coverage will vary across each metal level based on the cost-sharing required. For example, under the Silver Plan 70 HMO plan, 70% of expenses are paid by the Plan and 30% are paid by the member. We also offer a Minimum Coverage HMO plan (also known as catastrophic coverage) for applicants under the age of 30. Some people over the age of 30 may also enroll in the Minimum Coverage HMO plan if they meet certain requirements. Below is a description for each plan. The Benefits & Costs page show the amount you will pay for services under each plan.
If you do not qualify for financial assistance or prefer to purchase health coverage from us, you can apply for coverage directly with L.A. Care Health Plan. We offer the same health benefits and services through our five L.A. Care Covered Direct™ plans. For help selecting the best L.A. Care Covered Direct™ plan or information about enrollment, call us at 1-855-222-4239 (TTY 711). If you are ready to apply, you may download and complete the application.
*The Silver 94, Silver 87, and Silver 73 plans are only available to members who apply for coverage through Covered California™ and are found eligible for one of these plans based on their income. See the Financial Assistance page for more details.
Continuity of Care
If you now see providers who are not in the L.A. Care network, in certain cases you may be able to keep seeing them for up to 12 months. If your providers do not join the L.A. Care network by the end of 12 months, you will need to switch to providers in the L.A. Care network. You can continue to see your providers when:
- L.A. Care determines you have an existing relationship with your out-of-network provider. An existing relationship means you saw the out-of-network PCP or specialist at least once during the 12 months prior to the date of your initial enrollment with L.A. Care for a non-emergency visit.
- Your out-of-network provider is willing to accept the higher of L.A. Care’s contract rates or Medi-Cal FFS rates.
- Your out-of-network provider meets L.A. Care’s applicable professional standards and has no disqualifying quality-of-care issues.
- Your out-of-network provider is a California State Plan approved provider; and
- The provider supplies L.A. Care with relevant treatment information.
Members, their authorized representatives, or providers may make a direct continuity of care request to L.A. Care in writing or by telephone.
At any time, a member may change providers to a provider who is a member of an L.A. Care network.